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Trial record 1 of 1 for:    NCT01370733
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Synchronized Transcranial Magnetic Stimulation (sTMS) in Major Depressive Disorder (NEST-MDD)

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
NeoSync, Inc.
ClinicalTrials.gov Identifier:
NCT01370733
First received: June 8, 2011
Last updated: July 18, 2013
Last verified: July 2013
  Purpose

This study is designed to evaluate the safety and efficacy of synchronized transcranial magnetic stimulation (sTMS) using the NeoSync EEG Synchronized TMS device (NEST) in subjects with Major Depressive Disorder. This is a multicenter study in which subjects will be randomized to receive treatment 5 days per week for 6 weeks. Subjects who complete 6 weeks of double-blind treatment may be eligible to receive up to four weeks of open label sTMS therapy or antidepressant medications during the follow-up phase of the study. Follow-up evaluation visits will be conducted during those four weeks, with the frequency of the visits determined by the treatment choice during that timeframe.


Condition Intervention Phase
Major Depressive Disorder
Device: NEST-1 (NeoSync EEG Synchronized TMS)
Device: SHAM
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Evaluation of Low Emission NeoSync EEG Synchronized TMS Technology for the Treatment of Major Depressive Disorder: A Multicenter, Randomized, Double-Blind, Sham-Controlled, Trial

Further study details as provided by NeoSync, Inc.:

Primary Outcome Measures:
  • mean HAM-D17 total score change [ Time Frame: Baseline and Weekly throughout Treatment Period (up to week 6) ] [ Designated as safety issue: No ]
    The mean HAM-D17 total score change from Baseline (Day 0) to Week 6 and compared between the active treatment and sham-controlled groups


Secondary Outcome Measures:
  • Proportion of subjects who demonstrate clinical response at Week 6 or early termination, where response is defined by a reduction of at least 50% in the Baseline HAM-D17 [ Time Frame: Baseline and Throughout Treatment Period (up to week 6) ] [ Designated as safety issue: No ]
    Change from Baseline on the QOLI total score at Week 6 or early termination; Proportion of subjects who achieve remission at Week 6 or early termination, where remission is defined by a total score of ≤ 7 on the HAM-D17; Change from Baseline on the HAM-D17 anxiety subscale score at Week 6


Estimated Enrollment: 230
Study Start Date: June 2011
Estimated Study Completion Date: July 2013
Estimated Primary Completion Date: July 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Active sTMS Device: NEST-1 (NeoSync EEG Synchronized TMS)
The NeoSync EEG Synchronized TMS (NEST) is an electromechanical medical device that produces and delivers a sinusoidal magnetic field to areas of the brain in the treatment of Major Depressive Disorder.
Sham Comparator: Sham Device: SHAM
The sham device is configured to simulate the actual NEST-1 device without sTMS therapy being actively delivered.

Detailed Description:

Major Depressive Disorder (MDD) is a mental disorder associated with significant functional impairment and disability. Affected individuals present with depressed mood, loss of interest or pleasure, feelings of guilt, low self-worth, disturbed sleep or appetite, low energy, and poor concentration.

Psychopharmacological therapy as today's mainstream treatment has revolutionized the clinical management for major depressive disorders and has been shown to improve the quality of life for many patients. With that, these therapies are not effective for all patients. Results released from the Sequenced Treatment Alternatives to Relieve Depression Study (STAR*D), conducted by the National Institute of Mental Health (NIMH), show that approximately 30% of depressed subjects respond to an SSRI in their first trial, despite adequate dosing and duration of treatment. The SSRI antidepressants do have a more favorable side effect profile than older medications, but they still may be difficult for some patients to tolerate because of gastrointestinal distress, anxiety, insomnia, and sexual dysfunction.

In addition to the psychopharmacologic treatments for depression, other therapies such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have been shown to have a therapeutic effect in MDD. ECT induces seizures electrically in anesthetized subjects. It is generally safe and effective; however the procedure can have the negative side effect of memory loss and confusion. Treatment with repetitive stimulation (rTMS) is intended to stimulate groups of cells in areas of the brain linked to MDD. While the therapy is non-invasive, it is expensive, involves a complex method for locating the point of stimulation in the brain, and has the potential for seizures.

rTMS uses magnetic pulses which causes neuronal activation of specific areas in the brain. It is generally believed that this activation causes resetting of cortical oscillators to create a therapeutic effect in MDD. The investigators hypothesize that TMS using low energy, sinusoidal magnetic fields synchronized to a patient's individual alpha frequency,(sTMS), can also affect neuronal activity leading to a reemergence of intrinsic rhythms and clinical improvement in MDD. Preliminary study results using sTMS have shown improvements in depressive symptoms with minimal side effects.

This multicenter study is designed to evaluate the safety and efficacy of sTMS in subjects with Major Depressive Disorder. Subjects will be randomized to receive treatment 5 days per week for 6 weeks. At the end of Treatment Week 6, subject will have completed the study treatments and will be offered open label sTMS therapy or alternate antidepressant treatment as clinically indicated. At minimum, subjects will be asked to return for one follow-up visit four weeks after their last double-blind treatment (Week 10) for evaluation and study completion.

  Eligibility

Ages Eligible for Study:   22 Years to 65 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Subjects will meet the DSM-IV-TR primary diagnosis of initial or recurrent Major Depressive Disorder by DSM-IV-TR criteria rendered by structured interview using the Mini International Neuropsychiatric Interview (MINI).
  • HAM-D17 score >= 17 and Item 1 score greater than or equal to 2.
  • Duration of current episode >=8 weeks. The definition of an episode is demarcated by a period of >=2 months when the subject did not meet full criteria for the DSM-IV-TR definition of Major Depressive Episode. Maximum duration of current episode cannot exceed 2 years.
  • The baseline EEG is of sufficient duration and quality that it can be processed for quantitative analysis.
  • Subjects are willing and able to adhere to the intensive treatment schedule and all required study visits.

Exclusion Criteria:

  • Subjects are unable or unwilling to give informed consent.
  • Diagnosed with the following conditions (current unless otherwise stated):

    • Any other current primary Axis I mood, anxiety, or psychotic disorder, including bipolar disorder.
    • Depression secondary to a general medical condition, or substance-induced.
    • History of substance abuse or dependence within the past 6 months (except nicotine and caffeine).
    • Any bipolar disorder or psychotic disorder (lifetime), including schizoaffective disorder, or major depression with psychotic features in this or previous episodes.
    • Eating disorder (current or within the past year).
    • Obsessive compulsive disorder (lifetime).
    • Post-traumatic stress disorder (current or within the past year).
    • ADHD (currently being treated).
  • Subjects meeting criteria for Axis II cluster A or B diagnosis based upon DSM-IV TR criteria, which in the judgment of the Investigator may hinder the subjects in completing the procedures required by the study protocol.
  • Subjects with a clinically defined neurological disorder including, but not limited to:

    • Any condition likely to be associated with increased intracranial pressure.
    • Space occupying brain lesion.
    • Any history of seizure EXCEPT those therapeutically induced by ECT (childhood febrile seizures are acceptable and these subjects may be included in the study).
    • History of stroke.
    • Transient ischemic attack within two years.
    • Cerebral aneurysm.
    • Dementia.
    • Mini Mental Status Exam (MMSE-2) score of =<24.
    • Parkinson's disease.
    • Huntington's disease.
    • Multiple sclerosis.
    • Increased risk of seizure for any reason, including prior diagnosis of increased intracranial pressure (such as after large infarctions or trauma), or currently taking medication that lowers the seizure threshold. Medications that lower the seizure threshold are included in the Prohibited Concomitant Medication (Section 5.7).
  • Subjects who are currently hospitalized due to severity of depression symptoms.
  • Subjects with any of the following treatment histories:

    • TMS treatment within 6 months prior to the screening visit.
    • ECT treatment within 1 year prior to the screening visit.
    • Failure to respond to TMS or ECT treatment (i.e., consistent with ATHF confidence level 3 or higher) in this or any previous episode.
    • Lifetime history of treatment with Deep Brain Stimulation or Vagus Nerve Stimulation.
    • Use of any investigational drug or device within 4 weeks of the randomization visit.
    • Subjects who have been treated with fluoxetine within the past four weeks.
    • If participating in psychotherapy, must have been in stable treatment for at least 2 months prior to entry into the study, with no anticipation of change in the frequency of therapeutic sessions, or the therapeutic focus over the duration of the trial.
    • Failure to respond to Monoamine Oxidase Inhibitors (MAOIs) in the current episode.
  • Use of any medication(s) listed on the Prohibited Concomitant Medication within 1 week of randomization.
  • Subjects are adequately benefiting from current antidepressant medication(s).
  • Significant acute suicide risk, defined as:

    • Suicide attempt within the previous 6 months that required medical treatment; or
    • Greater than or equal to 1 suicide attempts in the past 12 months; or
    • Has a clear-cut plan for suicide and states that he/she cannot guarantee that he/she will call his/her regular psychiatrist or the Investigator if the impulse to implement the plan becomes substantial during the study; or
    • In the Investigator's opinion, is likely to attempt suicide within the next 6 months.
  • Cardiac pacemakers, implanted medication pumps, intracardiac lines, or acute, unstable cardiac disease.
  • Intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, stents, or electrodes) or any other metal object within or near the head, excluding the mouth, which cannot be safely removed.
  • Clinically significant abnormality or clinically significant unstable medical condition, as indicated by medical history, physical examination, ECG results, or clinical laboratory testing, that in the Investigator's judgment might pose a potential safety risk to the subject or limit interpretation of the trial results, e.g., any uncontrolled thyroid disorders, hepatic, cardiac, pulmonary and renal malfunctioning.
  • Women who are currently pregnant or not using a medically acceptable means of birth control and women who are breastfeeding.
  • Positive urine drug screen for illicit substances. (A positive urine drug screen at screening may be repeated once prior to randomization).
  • Any condition which in the judgment of the Investigator would prevent the subject from completion of the study.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01370733

Locations
United States, California
UCLA Depression Research & Clinic Program
Los Angeles, California, United States, 90024
UCSD Medical Center
San Diego, California, United States, 92103
UCLA-Harbor
Torrance, California, United States, 90509
United States, Connecticut
Hartford Hospital Institute of Living
Hartford, Connecticut, United States, 06106
United States, Illinois
TMS Specialists Chicago
Chicago, Illinois, United States, 60602
United States, Maryland
Sheppard Pratt Health System
Baltimore, Maryland, United States, 21285
United States, Missouri
Washington University School of Medicine
St. Louis, Missouri, United States, 63110
United States, Nebraska
University of Nebraska Medical Center
Omaha, Nebraska, United States, 68198
United States, New Jersey
Center for Mood Disorders and Neuromodulation Therapies, UMDNJ-SOM
Cherry Hill, New Jersey, United States, 08003
United States, New York
Mount Sinai School of Medicine
New York, New York, United States, 10029
United States, North Carolina
Duke University Brain Stimulation and Neurophysiology Center
Durham, North Carolina, United States, 27710
Wake Forest University Medical Center
Winston Salem, North Carolina, United States, 27157
United States, Pennsylvania
University of Pennsylvania
Philadelphia, Pennsylvania, United States, 19104
Mood Disorders Treatment Research Program University of Pittsburgh-Western Psychiatric Institute and Clinic
Pittsburgh, Pennsylvania, United States, 15213
United States, Rhode Island
Butler Hospital Mood Disorders Research Program, Brown Department of Psychiatry and Human Behavior
Providence, Rhode Island, United States, 02906
United States, South Carolina
MUSC Institute of Psychiatry, Brain Stimulation Lab
Charleston, South Carolina, United States, 29425
United States, Texas
UT Southwestern Medical Center
Dallas, Texas, United States, 75390
R/D Clinical Research
Lake Jackson, Texas, United States, 77566
Sponsors and Collaborators
NeoSync, Inc.
Investigators
Principal Investigator: Andrew Leuchter, MD UCLA Depression Research & Clinic Program
  More Information

Additional Information:
No publications provided

Responsible Party: NeoSync, Inc.
ClinicalTrials.gov Identifier: NCT01370733     History of Changes
Other Study ID Numbers: NND3001
Study First Received: June 8, 2011
Last Updated: July 18, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by NeoSync, Inc.:
TMS,
MDD,
Depression,
sTMS,
NEST,
NeoSync,
EEG,
synchronous,
non-invasive neuromodulation,
transcranial magnetic stimulation,
antidepressant,

Additional relevant MeSH terms:
Depression
Depressive Disorder
Depressive Disorder, Major
Disease
Behavioral Symptoms
Mental Disorders
Mood Disorders
Pathologic Processes

ClinicalTrials.gov processed this record on November 20, 2014